Recent sex trade and injection drug use among opiate and cocaine-dependent pregnant women in treatment: The significance of psychiatric comorbidity

Objectives: This study examined whether opioid and cocaine-dependent pregnant women with psychiatric comorbidity were at elevated risk for infectious disease by virtue of recent sex trade and injection drug use that overlapped with pregnancy. We hypothesized that opioid and cocaine-dependent women with psychiatric comorbidity would have greater odds for engaging in recent sex trade and injection drug use. Methods: Eighty-one, human immunodeficiency virus (HIV)-seronegative pregnant women (59.3% African-American, 37% White, and 3.7% other) who were enrolled in drug treatment in Baltimore, Maryland were recruited into an HIV prevention intervention study, provided informed consent, and attended an in-person, baseline assessment administered by trained clinicians. Assessments included The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision Axis I Disorders, the HIV Risk Behavior Interview, and a demographic questionnaire. The majority of women had lifetime histories of opioid and/or cocaine dependence (93.8%) and those with an additional lifetime nonsubstance-related Axis I disorder comprised the psychiatric comorbidity group. Results: Thirty percent reported recent sex trade and/or injection drug use that overlapped with pregnancy. Although psychiatric comorbidity was associated with 6 times the odds of opioid and cocaine-dependent pregnant women having recently traded sex, it was not associated with recent injection drug use. Conclusions: Findings underscore the need to (1) treat comorbid psychiatric disorders among pregnant women in treatment for cocaine and opioid dependence and (2) integrate HIV prevention interventions into drug-dependence treatment for pregnant women, particularly those with psychiatric comorbidity given their elevated risk for infectious disease.